Department of Emergency Medicine, Gulhane Military Medical Academy, Ankara, Turkey
Received date: January 15, 2016; Accepted date: September 08, 2017; Published date: September 15, 2017
Citation: Yildirim AO, Demir M, Demirkol S, Unlu M, Ozturk C, et al. (2017) Visible Thrombus and Ruptured Plaque in Right Coronary Artery. J Thrombo Cir 3:122. doi:10.4172/2572-9462.1000122
Copyright: © 2017 Yildirim AO, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Atherosclerotic plaque rupture and subsequent thrombosis are major pathophysiological mechanisms as cause of acute coronary syndromes. Patients with stable obstructive coronary artery disease may live for many years without any cardiovascular events through only risk factor modification and prompt medical treatment. However patients with minimal coronary artery disease may experience premature cardiovascular events moreover death. Thus, plaque stabilization may be much important rather than struggle with stenosis. We report a case of NSETMI with ruptured atherosclerotic plaque and subsequent thrombosis as a culprit lesion in right coronary artery.
Acute coronary syndromes; Atherosclerotic plaque rupture; Thrombosis; Coronary angiography; Plaque stabilization
A 66 years old smoker male with history of CAD is presented with episode of retrosternal chest pain that last 30 minutes. The patient has not any chest pain during admitted to hospital. Physical findings are not significant . ECG does not show any abnormality aside from inverse T wave in inferior leads. Troponin T and CK-MB are elevated.
Another biochemical tests are not abnormal. Echocardiography does not show any wall motion abnormality and Left ventricular ejection fraction is 50%. Aspirin and Ticagrelor is given. Coronary angiography reveals visible thrombus in right coronary artery (Figure 1) and diffuse stenosis in circumflex artery that filling through distal collaterals (Figure 2).
One year ago same patient’s coronary angiography showed moderate atherosclerotic plaque without any visible thrombus in right coronary artery (Figure 3). We think that culprit lesion is in right coronary artery. We decide performing PCI for right coronary artery.
When 0.014 guidewire intercross the lesion, distal flow is off and contrast media stasis in the myocardium (Figure 4). RCA stenting is immediately performed. Heparin and Absciximab infusion is started. The patient is admitted to coronary care unit.
What are we know regarding coronary artery disease and acute coronary syndromes? What are-difference between stable coronary artery disease and acute coronary syndromes? Atherosclerotic plaque rupture and subsequent thrombosis are major pathophysiological mechanisms as causes of acute coronary syndromes as well our case. One year ago the patient’s coronary angiography shows diffuse serious lesion in circumflex artery and non-obstructive plaques in right coronary artery. Although lesions in circumflex coronary artery are critical than these in right coronary artery, plaque rupture and subsequent thrombosis occurred in right coronary artery. Thus plaque stabilization and preventive of thrombosis may be important. Distal embolisation during PCI is important problem. Prompt anticoagulant and antiplatelet agents should be given previous and during procedure.